Geriatric care & problems.pptx

This is a ppt discussing problems of geriatric age group and its prevention

1. Geriatric Care

2. Definition AGING : It is a progressive and generalized impairment of body functions resulting in, loss of adaptive responses to stress and increasing the risk of age-related diseases. Greek: gerus = old age iatrea = treatment Geriatrics: A branch of medicine that deals with the problems and diseases of old age and aging people. Gerontology : Comprehensive study of aging and the problems of the aged. People more than 60 yrs are considered elderly. Old age is not a disease but a normal and inevitable biological phenomenon.

3. Definition of elderly According to WHO , most developed countries have accepted the chronological age of 65 years and above as a definition of 'elderly' or older persons. According to UN : 60+ years will be referred as the older population or elderly. Young old – upto 75 years. Old old – upto 85 years. Very old – over 85 years.

4. Branches of geriatrics Gerontology Clinical gerontology Social gerontology Geriatric gynecology Experimental gerontology Preventive gerontology

5. World Population trend of 60+ Years 1980-2020 ( in millions) 1980 1990 2000 2010 2020 World 381.2 484.7 608.7 754.2 1011.6 Developed 173.3 203.6 234.6 232.4 308.2 Developing 207.9 281.8 374.1 491.8 703.4 Asia (excl. Japan) 160 218.2 290 377.7 539.9 China 78.6 101.2 131.7 167.9 238.9 India 44.6 60.2 81.4 107 149.7 United Nations, World Demographic Estimate and Projections

6. Elderly Population in India With a comparatively young population, India is still poised to become home to the second largest number of older persons in the world. Projection studies indicate that the number of 60+ in India will increase from 100 million in 2013 to 198 million in 2030. In 2001, the proportion of older people was 7.7% which increased to 8.94% in 2016.

7. Elderly Population in India The life expectancy at birth in India is as follows: Japan is the most elderly country in the whole world with average life span of 82 years. Year In males (in years) In females (in years) 1996-2001 62.3 63.39 2011-2016 67.04 68.8

8. In Census 2011, 8.6 % of persons are in age group 60+ years compared to 7.4 % in Census 2001 Aged persons have increased in all the States and UTs, except in Daman & Diu

9. The special features of the elderly population in India are : Majority (80%) of them are in the rural areas, thus making service delivery a challenge, Feminization of the elderly population ( 51% of the elderly population would be women by the year 2016) Increase in the number of the older-old ( persons above 80 years) and Large percentage (30%) of the elderly are below poverty line. Source: Operational guidelines (National programme for Health care of the elderly (NPHCE), pg : 9

10. The Problems of the Old Physiological problems Pathological problems Psychological problems Mental problems Social problems Economical problems

11. Physiological problems Loss of elasticity of the skin, thinning and loss of hair, Brittleness of bones and weakness of muscles, slowness of movements, unsteadiness of gait, and Sluggishness of reflexes Impairment of the special senses, especially hearing and sight Accidents, often at home, are an important cause of physical illness in the elderly. Falls are the leading cause of death among people aged 75+ and responsible for appreciable morbidity including fracture, impaired mobility. Immune system become weak. Metabolism starts slowing down.

12. Pathological Problems Diseases of the heart & blood vessels, e.g.: hypertension, atherosclerosis, CVDs, MI, IHDs, Stroke etc Cancer, Diabetes, Obesity Diseases of the eye Cataract Loss of vision Reduced visual acuity Age-related macular degeneration (AMD) Retinopathy

13. Pathological Problems Diseases of respiratory systems Chronic bronchitis Bronchial asthma Emphysema etc Diseases of genitourinary system Enlargement of prostate Incontinence of urine Dysuria Nocturia Urinary tract infection Fecal incontinence

14. Locomotor system disorders It forms 40% of the old age complaints They are: Fibrositis Osteoarthritis Rheumatoid arthritis Myositis Neuritis Gout Spondilitis of spine

15. Musculo-skeletal system Irreversible loss of motor units and fibres Reduced muscle strength Locomotor disability Deposition of fat Loss of mineralisation Osteoporosis Pathological fractures Wear-n-tear of articular cartilage OA and RA Mobility problems

16. Psychological problems Mental changes: Loss of memory, senile dementia Isolation: Death of closed ones, lack of care, social maladjustments isolation Depression: factors like isolation, poverty, diseases, emotional disturbances, lack of happiness etc , leads to depression. Psychological problems form 8.5% of the old age complaints 4. Neurological problems form 18.7% of the old age complaints 5. These are: Dementia Parkinson's disease Alzheimer’s disease

17. Skin conditions Skin conditions form a major part of old age complaints Skin conditions include: Senile wrinkles Scaly lesions Scaly dermatosis Blistering diseases Neoplastic disorders

18. Skin and its appendages Loss of elasticity of skin Wrinkling Loss of hair Alopecia and baldness Brittleness of fingernails

19. Gastrointestinal complaints GI disorders for about 9% of the old age complaints These are: Peptic ulcer Constipation Ulcerative colitis Carcinoma of GIT Atrophy of mucous membrane of mouth Reduced food intake and change of taste and smell Nutritional deficiency states Loss of teeth same as above Decreased no. of taste buds same as above Decreased salivation same as above Decreased sensation of smell same as above

20. Hearing loss Hearing complaints form about 8.2% of the old age complaints These include Nerve deafness Conductive hearing loss

21. Geriatric Gynecology Atrophy of vaginal and urethral mucosa UTI’s and atrophic vaginitis Carcinoma cervix Weakening of pelvic muscles Prolapse of uterus Ulceration and carcinomatous change

22. Haematology Reduced bone marrow reserve Anaemias Reduced T-cell function Non-resolving infections Prone to infections Increased synthesis of auto-antibodies Auto-immune disorders

23. Social problems Abuse : The abuse may be of a physical nature, it may be psychological (involving emotional or verbal aggression), or it may involve financial or other material maltreatment. Dependancy :PHYSICAL, FINANCIAL, FUNCTIONAL and other dependancy has a major affect on the self esteem of the old. Insecurity :Insecurity of being abandoned by their children. Rehabilitation

24. Elder Abuse It refers to ill-treatment of an elderly person. It can be-physical abuse -psychological abuse -financial abuse -Neglect. It is a very sensitive issue and requires a high index of suspicion.

25. Need for geriatrics Elderly population will keep on rising due to advancing medical technology. Diseases present atypically and at an earlier stage. Often a multi-organ system involvement. Worsening of pre-existing diseases are frequent. Burden over the health care system. Burden over the nations economy.

26. PREVENTION AND MANAGEMENT

27. Prevention and Management of Health Problems in Geriatrics One of the most important measure of how civilized we are is how we treat our elderly. According to Sir James Sterling Ross ”you do not heal old age, you protect it, you promote it and you extend it.”

28. Components of assessment Physical Functional Psychological- cognitive affective Socio-economical Environmental

29. Assessment of the elderly AIMS – Cost effective use of services. Maintaining the elderly active. Providing quality care up to the max. satisfaction of the user.

30. Multi-disciplinary Geriatric Assessment (Geriatric Clinic) The concept of geriatric clinic suits best for assessment and management of diseases and disabilities in the elderly. Components- Gerontologist/Physician Physiotherapist Occupational therapist Ophthalmologist Audiologist Psychiatrist Dietitian Nurse and Social worker.

31. Scope- This facility is available only at tertiary and few secondary health care centers. In a primary health care set-up, a trained physician, a trained nurse and a physiotherapist should be able to assess the elderly fairly well.

32. Preventive Health Care in Elderly It includes- Primary prevention. Secondary prevention. Tertiary prevention.

33. Primary prevention Control of BP, Weight, diabetes if any Avoid smoking, limit alchohol Regular moderate physical exercise, yoga, meditation Avoidance of drug abuse and self medication Well balanced diet, low saturated fatty acids, refined sugars and fast food More calcium rich diet, fruits and vegetables Reading, writing, listening to music, doing puzzles, suduku , etc Avoid loneliness Drink enough water Periodical health check ups Financial Security Health Promotion:

34. Primary prevention Immunization- Influenza Pneumococcal Tetanus. Hepatitis B Osteoporosis prevention- Calcium and vit -d supplementation. Hip protector devices. Specific protection:

35. Injury prevention Burns accidents and falls should be prevented by;- Removal of obstacles Keep the floor dry Bright lighting Flat shoes Railing/holding bars in bathrooms Low level switches Easy and safe access to water .

36. Secondary prevention Screening helps in early detection of modifiable risk factors and their adequate management. Hyper/hypotension, diabetes mellitus Dental problems Drug adverse effects Cancers Infections Nutritional deficiency states Eyes /ears Screening

37. Tertiary prevention Consists of giving intensive treatment in the hospital for those who come in advanced stage of disease. Disability Limitation:

38. Tertiary prevention It deals with rehabilitation and caregiver support. Rehabilitation is a problem solving process focused on the patients functional abilities. Rehabilitation team includes; a physician, a physiotherapist, an occupational therapist, a speech and language therapist, a psychiatrist, a dietitian, a nurse and a social worker. Rehabilitation:

39. Interventions in rehabilitation Hard interventions: drugs. physiotherapy. occupational therapy. aids and adaptation-Hearing aids, artificial limbs speech and language therapist. Soft interventions- advice. education. counseling. encouragement. listening.

40. Supporting the caregiver Social attitude Physicians support Organization of “day care centers” Hospitalization in c/o chronic illness Counseling the caregiver

41. Prevention and management of elder abuse Assessment of physical and mental capacity of the elderly. Assessment of general quality of care Assessment of relation with the abuser Assessment of abusers for their problems Counseling the abusers Institutionalization in old age homes

42. Thank you